Response to repetitive cycles of ovulation induction in the same women

It has been theorized that the administration of human menopausal gonadotropin (hMG) in consecutive menstrual cycles will result in a poor follicular response in the second cycle. To examine this, 50 women undergoing ovulation induction in two consecutive cycles were assessed, using in each the same induction regimen during the initial 5 days. The remainder of each cycle was individualized according to their response. Nine women were anovulatory, 19 were oligoovulatory, and 22 ovulated regularly in unstimulated cycles. In repeat cycles only 3 of 50 had poor follicular development and did not receive human chorionic gonadotropin (hCG); all were anovulatory. Forty-two of 50 of the first cycles had continually rising estradiol (E₂), while 43 of 47 of the second cycles had rising E₂ patterns. Grouping the peak E₂ prior to hCG in the ranges <300, 300-699, 700-1099, and ≥1100 pg/ml, peaks in the second cycle were similar in 25 of 50, lower in 16, and higher in 9. Only 3 of 9 anovulatory women had similar peaks, as compared to 22 of 41 of the oligoovulatory and regularly ovulating women. Comparing the second to the first cycle, the day of hCG was within 1 day in 28 of 50 women, 2 or more days less than the first cycle in 6, and 2 or more days greater than the first cycle in 11. We conclude that in a successive cycle of ovulation induction (i) the follicular response is impaired in anovulatory women, but (ii) in oligoovulatory or regularly ovulating women, clinically significant differences in the estradiol response do not occur.